HomeAnswersInternal MedicinehypertensionI have BP, irregular heartbeat, and anxiety. Please help.

How can I manage anxiety and high blood pressure issues?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At August 25, 2022
Reviewed AtDecember 13, 2023

Patient's Query

Hello doctor,

I have high blood pressure, and my heart rates are high. Kindly review my reports and let me know what treatment I should take.

Thank you.

Hello,

Welcome to icliniq.com.

I have read your query.

I saw the files you have attached (attachment removed to protect the patient's identity). My suggestions are:

1. Your electrocardiogram (ECG) has sinus tachycardia means your heart rate is above 100 beats per minute and the origin of the action potential of the heart is from the sinus node only, which is normal.

2. In the electrocardiogram (ECG), there is no arrhythmia.

3. Treadmill test (TMT) is negative for reversible myocardial ischemia (RMI), which is good.

4. 2-D echocardiogram (ECHO) test is normal with left ventricular ejection fraction (LVEF) at 60 percent, and mild left ventricle hypertrophy (LVH) is present.

5. Left ventricle hypertrophy means the left ventricle has undergone a mild increase in thickness because it pumps blood against chronically elevated blood pressure in the artery. It means you have chronically elevated high blood pressure.

My questions to you are the following.

1. Are you taking any medicine for high blood pressure?

2. Do you get any chest pain on exertion?

3. Any breathing difficulty or episodes of giddiness?

4. Are you taking any medicine for tachycardia?

5. What complaints do you have for which you have done the above tests?

6. Have you checked your blood pressure? Is it high most of the time?

7. Do you take any medicine for hyperthyroidism?

Please reply to the above questions to guide you further.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Before, I took Amlodipine 5 mg, and later my doctor changed it to Diltiazem. But later, I shifted from that place to another country, and Diltiazem did not work out well at that time. Thus another doctor gave me Amtas-M (5/50 mg), which is working well now. I am not having any chest pain or difficulty breathing. But I have anxiety, so I am using Alprazolam 0.25 mg. During a panic attack, my heart rate will relax and control and ease difficult breathing.

My questions are:

1. Is this heart disease or panic attack?

2. I have had anxiety disorder for five years now. What to do?

3. Do I need to do another test for the heart?

4. My doctor said nothing relevant was found, and it is better to see a cardiologist. However, my white blood cell (WBC) count was too high, and the doctor gave me Vancomycin liquid antibiotics in six bags. Why?

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

After analyzing your condition, I have the following suggestions.

1. At present, there is no evidence of heart disease in the reports. There is no structural heart disease as the 2-D echocardiogram (ECHO) report is normal, and no valvular abnormality present.

2. There is no evidence of coronary artery disease as the treadmill test (TMT) is normal or negative.

3. Left ventricular ejection fraction (LVEF) is 60 percent, indicating adequate cardiac output.

4. There is no arrhythmia present in the electrocardiography (ECG).

5. You have mentioned in your medical history about a panic attack. You should continue with Amtas-M (Amlodipine 5 mg and Metoprolol 50 mg) 5/50 mg. Panic disorder can cause sinus tachycardia.

6. In the echocardiogram (ECHO), left ventricular hypertrophy is present due to high systemic blood pressure.

7. In my opinion, there is no need for further cardiac evaluation.

8. Please take the cardiologist's opinion also.

9. You should take treatment for anxiety disorder, as you have mentioned in your medical history. Please visit a psychiatrist to evaluate anxiety disorder and take psychological therapy for the anxiety.

10. Along with medicine for anxiety, psychological therapy would also help you to relieve anxiety. Chronic anxiety can cause an increase in the heart rate and an increase in blood pressure. Chronic increase in blood pressure can cause left ventricular hypertrophy.

11. Take treatment for the root cause, which is anxiety.

I do not know why Vancomycin (glycopeptide antibiotic) was given to you. However, you can follow up and consult regarding your anxiety problem and get counseled for the same.

Please do the following tests and consult again.

1. Lipid profile.

2. Fasting blood sugar (FBS).

3. Postprandial blood sugar ( PPBS).

4. Renal function test (RFT).

5. Liver function test (LFT).

I hope you find my reply helpful.

Please follow up if you have any further related queries about it.

Thank you.

Patient's Query

Hello doctor,

Thank you for your suggestions.

Here I am attaching the blood reports for further suggestions.

Thank you.

Hello,

Welcome back to icliniq.com.

Thanks for the follow-up.

I saw the file you have attached (attachment removed to protect the patient's identity). The following are my suggestions.

1. The values are normal in the report except for mildly elevated white blood count (WBC).

2. Increased value at that time may be because of some infection, and I think the doctor gave you antibiotics.

3. Any low-power antibiotic other than Vancomycin would also have worked.

4. The renal function test is normal.

I suggest you do the following tests again, as the reports are old.

1. Lipid profile.

2. Renal function test (RFT).

3. Liver function test (LFT).

4. Fasting blood sugar (FBS).

5. Postpandrial blood sugar (PPBS).

6. Complete blood count (CBC).

Keep these test reports as a baseline, and you will also come to know the present biochemistry level. Since you were taking medicine for blood pressure and underwent a recent cardiac evaluation, doing the above tests is essential as these tests are part of the cardiac evaluation. You can send me a report after you get the above tests done, and I will guide how to proceed further in terms of diet, exercise, and medication if needed. I want to add that you should exercise daily and do breathing relaxation techniques as it helps to lower anxiety levels. Continue taking the recommended high blood pressure medication regularly and monitor your blood pressure levels.

Please follow up if you have any further related queries about it.

Thank you.

Patient's Query

Hello doctor,

Thank you for your suggestions.

The following are the findings from my blood reposts.

1. Triglycerides is 191 mg/dL.

2. Cholesterol 161 mg/dL.

3. LDL 89 mg/dL.

4. HDL 41 mg/dL.

A thyroid test was done three months back, and do I need to do that again?

Thank you.

Hello,

Welcome back to icliniq.com.

All values of the lipid profile are also normal except for high cholesterol. It should be below 100 mg/dL for better health. No need to do the thyroid tests again.

I suggest taking a healthy, balanced diet, engaging in morning exercises daily, practicing breathing relaxation techniques, continuing blood pressure medicine, monitoring blood pressure, and trying to lower anxiety levels. There is only mild left ventricular hypertrophy due to high blood pressure, and the rest of the heart condition is healthy.

I hope you find my reply helpful.

Please follow up if you have any further related queries about it.

Thank You.

Patient's Query

Hello doctor,

Thank you for your reply.

Sometimes I have an elevated heartbeat, and later, I develop an anxiety-like condition. When these anxiety issues occur, I take half Alprazolam tablets; after that, I feel relaxed, and my heart rate will slow down. This has happened multiple times in my life. So is it anxiety or something else?

Kindly help.

Thank you.

Hello,

Welcome back to icliniq.com.

Most likely, it is due to anxiety. Alprazolam (Benzodiazepines) reduces anxiety episodes. During anxiety, the heart rate goes up, and since you are responding to tablet Alprazolam, it is most likely due to anxiety only. My questions are:

1. What kind of anxiety do you have?

2. What triggers your anxious feelings?

Also, you are taking tablet Amtas-M (Amlodipine and Metoprolol) 5/50 mg. It contains Amlodipine 5 mg and Metoprolol 50 mg. Metoprolol also helps reduce heart rate and lowers blood pressure by controlling heart rate. I want to know the cause of your anxiety. So I suggest you the following measures:

1. Keep yourself active by exercising regularly.

2. Eat a healthy diet and free yourself from psychological problems as much as possible.

3. Take your medications regularly and monitor your blood pressure levels frequently.

Please follow up if you have any further queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply.

I have anxiety issues due to my fear of death. What do you think is the reason behind all these symptoms? Is it because of heart disease or other issues?

Please reply.

Thank you.

Hello,

Welcome back to icliniq.com

I read your query and understood your concern.

I think you need professional counseling regarding your anxiety disorder. It will be better if you consult a specialist nearby and take the necessary guidance.

You can contact me for further consultation if you have any queries.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

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